PURPOSE: The purpose of this study was to identify the process of overcoming the intention toward turnover experienced by career nurses. METHODS: Data were collected from 10 career nurses though in-depth interviews about their experiences. The main question was "How do you describe your experience of the process of overcoming intention to turnover as a career nurse?" Qualitative data from field and transcribed notes were analyzed using Strauss & Corbin's grounded theory methodology. RESULTS: From the participants' statement, 127 concepts, 34 subcategories and 13 categories were extracted through the open coding process. The core category was discovered to be 'back to the original place'. Phenomenon was identified as 'reached the threshold that cannot be withstood' and this series of process was categorized as having four stages: 'conflict', 'meditation', 'discovery' and 'conquest'. There were three types of overcoming turnover intention in career nurses, 'adjustment', 'compromise', 'self-led'. CONCLUSION: The results of this study produced useful information about the needs of career nurses during the process of overcoming turnover intention based on their stage and overcoming types of turnover intension. Ultimately this study may help decrease the turnover intention of career nurses.
Clinical Coding ; Intention

We reviewed four patients who underwent posterior C-D occipitocervical loop and autogenous bone graft. The mean postoperative follow-up period was 16 months. The indications for surgery were progressive neurological deficit, atlantoaxial instability and intractable pain. Of the four patients, one had os odontoideum, two rheumatoid arthritis and suboccipital dislocation combined fractures of C1 and C2. Bong union was confirmed in all cases at approximately 4 months postoperatively. Final outcome result was satisfactory in three patients and unsatisfactory in one patient. The cause of unsatisfactory result was recurrent neck pain secondary to swan neck deformity. The neurologic deficit were improved or remained same as preoperative status. Three patient were out of bed on average of the 14th day postoperatively. One patient could not ambulate due to tetraplegia who needed an artificial ventilator. There was no complication related to instrumentation.
Arthritis, Rheumatoid ; Congenital Abnormalities ; Dislocations ; Follow-Up Studies ; Humans ; Neck ; Neck Pain ; Neurologic Manifestations ; Pain, Intractable ; Quadriplegia ; Transplants ; Ventilators, Mechanical

PURPOSE: Childbirth self-efficacy plays an important role in women's ability to cope with labor and delivery. Coaching has been gaining popularity as a way to promote cognitive, emotional and behavioral change. This study aimed to test the effects of a Coaching-based childbirth program on anxiety and childbirth self-efficacy among primigravida women. METHODS: The study design was a quasi-experimental pre-post design. A coaching-based childbirth program was developed synthesizing concepts and techniques from the literature on coaching and was verified by an expert panel. It consisted of four weekly 2-hour small group sessions. Pregnant women were recruited from H hospital in Seoul. Childbirth self-efficacy and state anxiety were measured before and after the program. RESULTS: Although there was a no significant reduction in anxiety, there were statistically significant increase for childbirth self-efficacy in the experimental group when compared to the control group. CONCLUSION: The program appears to increase childbirth self-efficacy for pregnant women. Future studies may benefit from using mixed coaching modalities and consider measuring health behaviors and obstetric outcomes to gain insights on its long-term impact.
Anxiety ; Female ; Health Behavior ; Humans ; Parturition ; Phosphatidylethanolamines ; Pregnant Women

BACKGROUND: Propofol and lidocaine have been purported to attenuate bronchoconstriction induced by fentanyl administration during induction of anesthesia. The purpose of the present study was to study the synergic bronchodilation effect of propofol mixed with lidocaine. METHODS: Two hundred and thirty four patients were randomly allocated to five groups: Group 1 (n = 60, normal saline 0.25 ml/kg followed by fentanyl 3ng/kg), Group 2 (n = 30, propofol 2 mg/kg mixed with normal saline 0.05 ml/kg followed by normal saline 0.06 ml/kg), Group 3 (n = 50, propofol 2 mg/kg mixed with normal saline 0.05 ml/kg followed by fentanyl 3ng/kg), Group 4 (n = 33, propofol 2 mg/kg mixed with lidocaine 1 mg/kg followed by normal saline 0.06 ml/kg) and Group 5 (n = 61, propofol 2 mg/kg mixed with lidocaine 1 mg/kg followed by fentanyl 3ng/kg). All patients were injected with fentanyl or normal saline two minutes after administration of propofol premixed with lidocaine or normal saline, respectively. We checked the cough reflex, injection pain, oxygen desaturation and chest wall rigidity. RESULTS: There was a significant difference in the incidence of cough reflex between group 1 and 3 or 5. The incidience of group 5 was significantly lower than in group 3. CONCLUSIONS: This study suggests that a propofol-lidocaine mixture should be considered when patients require bronchodilation during induction of anesthesia.
Anesthesia ; Bronchoconstriction ; Cough* ; Fentanyl* ; Humans ; Incidence ; Lidocaine* ; Oxygen ; Propofol* ; Reflex* ; Thoracic Wall

Small heterodimer partner (SHP) is an atypical member of nuclear receptor superfamily that lacks a DNA-binding domain. In previous study, we showed that SHP, c-jun, p65 of NF-kappaB subunits, and p21WAF1 expression was increased during monocytic differentiaton with the exposure of human leukemia cells to a differentiation agent, PMA. In this study, c-Jun and p65 were shown to mediate the transcriptional activation of the SHP promoter. In addition, SHP induced the cell cycle regulatory protein levels and cooperatively increased an induction of p21WAF1 expression with p65. Furthermore, SHP protected differentiated cells from etoposide-induced cellular apoptosis through the induction and cytoplasmic sequestration of p21WAF1. Complex formation between SHP and p21WAF1 was demonstrated by means of coimmunoprecipitation. These results suggest that SHP prolongs a cellular survival of differentiating monocytes through the transcriptional regulation of target genes of cell survival and differentiation.
*Apoptosis ; Cell Differentiation ; Cell Line, Tumor ; Cyclin-Dependent Kinase Inhibitor p21/genetics/*metabolism ; Gene Expression Regulation ; Humans ; Monocytes/cytology ; Promoter Regions, Genetic ; Proto-Oncogene Proteins c-jun/genetics/metabolism ; Receptors, Cytoplasmic and Nuclear/genetics/*metabolism ; Transcription Factor RelA/genetics/metabolism

Curschmann's spirals morphologically similar to those seen in sputum were found in cervico-vaginal smears of six patients ranged from 28 to 40 years of age, during 18 months from January. 1985 to June, 1986. The prevalence was 1 in 2147 smears in that period. All of them had gynecologic disorders without systemic effect such as chronic cervictis in three, leiomyoma in one, pelvic inflammatory disorder in one, and primary infertility in one. The Curshmann's spirals in the smear showed varying degrees of maturation from wavy incipient ones to highly coiled mature ones, admixed with thick mucinous back- ground, suggesting of their production in the uterine cervix itself. Also the recent history of undergone cryocautery, electrocautery or parturition suggest its production in the endocervical gland due to mechanical obstruction and/or change in biochemical composition of mucus.
Cervix Uteri ; Diabetes Insipidus* ; Electrocoagulation ; Female ; Humans ; Infertility ; Leiomyoma ; Mucins ; Mucus ; Parturition ; Pedigree* ; Pilomatrixoma ; Prevalence ; Receptors, Vasopressin* ; Sputum ; Vasopressins*

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*

Background: Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance. Methods: This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695. Results: The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356). Conclusion The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.

BACKGROUND: All fifteen laboratories of Korean Association of Health Promotion were used to use different reference ranges that were mostly adapted from the published data or the recommended data by the reagent companies supplied as inserts. These created problems such as inadequate interpretation, inability of exchangeable patient data, and subsequent confusion, and all the data stored became useless particularly in the respect of health statistics. The purpose of this study was to solve such problems through defining commonly acceptable reference ranges. METHODS: All the results performed during October 1, 2000 through September 31, 2001 were collected in preferably 'Excel' file format. All the data included the necessary information such as age and sex. The age was grouped in six; baby (0-3y), children (4-12y), adolescent (13-18y), adult (19-64y), younger elderly (65-79y), old elderly (over 80y), with references of statistics in medical informatics and WHO classification. The data were statistically analyzed with SAS 6.04 for Gaussian distribution. None of the tests showed Gaussian distribution. These procedures had been repeated twice or three times after trimming out the results lying outside three standard deviations. Though, all the tests showed non-Gaussian distribution. Subsequently, the reference ranges were defined in the range from the point of lower 2.5% to the point of higher 97.5%. And in case the lower range could be "0", the reference ranges were defined in the range of 0 to 95%. RESULTS: The reference ranges of 56 test items were newly assigned. Among these there were eight tests that needed reference ranges by the age groups and nine tests by the sex. CONCLUSIONS: All 15 laboratories of Korean Association of Health Promotion now have the same reference ranges that were statistically derived from their own data. This means the patient data and reference values can be exchangeable among their laboratories.
Adolescent ; Adult ; Aged ; Child ; Classification ; Deception ; Health Promotion* ; Humans ; Medical Informatics ; Reference Values*